Provider Demographics
NPI:1538202569
Name:TUCKER, SCOTT LLOYD (AT,C)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:LLOYD
Last Name:TUCKER
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6971 SAN PEDRO CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2930
Mailing Address - Country:US
Mailing Address - Phone:714-220-1789
Mailing Address - Fax:
Practice Address - Street 1:9200 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5805
Practice Address - Country:US
Practice Address - Phone:714-484-7381
Practice Address - Fax:714-484-7448
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer